Kiwiology Posted June 29, 2011 Posted June 29, 2011 (edited) 1:100,000 adrenaline IV as an infusion (1mg in 1 litre of 0.9% NaCl) run at 2gtt/s titrate Agree that an EtCO2 of 32 will tell you not a lot about his PCO2 but it may be slightly high I'd be ringing up for an Intensive Care Paramedic to rv with us and taking this kid to the hospital without waiting for them to come to me ... with much of the expediciousness Edited June 29, 2011 by kiwimedic
usalsfyre Posted June 29, 2011 Posted June 29, 2011 Pretty well agree with above. Epi, nebs, steroids, consider mag, watch out for the pneumo and hold RSI if at all possible. If I have to tube him Ketamine has some nice bronchodilatory effects, keeps him "awake" and more importantly breathing on his own prior to dropping the tube, I'd consider doing it awake with a lidocaine topical as well. An ETCO2 of 32 tells me...he's got an ETCO2 of 32. Without an arterial gas it's impossible to correlate the two. He's obviously got massively impaired gas exchange. I'll bet once he opens up a bit that number rises like the national debt...
Kiwiology Posted June 29, 2011 Posted June 29, 2011 If I have to tube him Ketamine ... keeps him "awake" Right, that is why we use it to knock people out
usalsfyre Posted June 29, 2011 Posted June 29, 2011 Right, that is why we use it to knock people out And why I VERY much wish we carried it, among other reasons.
Kiwiology Posted June 30, 2011 Posted June 30, 2011 And why I VERY much wish we carried it, among other reasons. We both know everything is badass in Texas, and that Texas has no legislated restriction on scope of practice, if the Medical Director says you can do it, by God you can do it! Go ask his ass for ketamine
usalsfyre Posted June 30, 2011 Posted June 30, 2011 We both know everything is badass in Texas, and that Texas has no legislated restriction on scope of practice, if the Medical Director says you can do it, by God you can do it! Go ask his ass for ketamine We have. Seems it's not the group asking for it he has concerns about. Plus something about a controlled substance with hallucinogenic properties that doesn't show up on a standard UDS makes administration nervous...
Kiwiology Posted June 30, 2011 Posted June 30, 2011 We have. Seems it's not the group asking for it he has concerns about. Plus something about a controlled substance with hallucinogenic properties that doesn't show up on a standard UDS makes administration nervous... Rubbish, I have only seen one bloke have a bad trip on ketamine ... none of us in AU, EU or NZ seem to think its a problem And if your people can't be trusted with ketamine because they'll nick down to the local rave with it, party up large and die of water intoxication or something silly like that then you should find new employees.
DartmouthDave Posted June 30, 2011 Posted June 30, 2011 Hello, I just read the whole thread. Pardon me if I am repeating a previous post I may have missed. This fellow has a failure to ventilate due to hyperinflation. So, ETCO2 won't be accurate. By this late stage, his minute ventilation will be very low. Low minute ventilation equals an increasing PaCO2. Also, bagging in the nebs I feel would be a bad idea. Again, bagging a tight asthmatic is looking for trouble. So, as posted by others, treating with Ventolin, MgSO4, and Steroids (for long term management) with some Epi on standby are all good ideas. I have no experience with ped asthma patients in the field. But, I have seen quite a few in the ED setting. All have responded to medical management.....after a long period of pucker factor that is. =) Mobey, how did things turn out at the ED with this patient? Cheers
mobey Posted June 30, 2011 Author Posted June 30, 2011 I have no experience with ped asthma patients in the field. But, I have seen quite a few in the ED setting. All have responded to medical management.....after a long period of pucker factor that is. =) Mobey, how did things turn out at the ED with this patient? Cheers Yes long pucker factor as well. It stands to reason that we do not intubate these people unless we have to, from what I am told, they are very difficult to wean off the ventilator. This child turned out very well. Totals of meds used were Ventolin (continuous neb) Atrovent 500mcg MgSo4 600mg Dexamethasone 16mg Epi 1:1000 5mg nebulized The ETc02 question I posted was pretty well answered by Dave & Dwayne. The takehome point I was trying to make is "EtC02 will give a minimum PC02 reading" That is to say, if the EtC02 is 32 you can assume the PC02 is at least 32. The PC02 may very well be higher, but it will be at least what the EtC02 is. 1
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